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GENERAL TOPICS:
 What is a Pediatric Dentist?
Why Are The
Primary Teeth So Important
Eruption Of Your Child’s
Teeth
Dental
Emergencies
Dental
Radiographs (X-rays)
What's the Best Toothpaste for my Child?
Does your Child Grind his Teeth at Night? (Bruxism)
Thumb Sucking
What is
Pulp Therapy?
What is
the Best Time for Orthodontic Treatment?
EARLY INFANT ORAL CARE:
Your Child's First Dental
Visit
When will my Baby
Start Getting Teeth?
Baby
Bottle Tooth Decay (Early Childhood Caries)
PREVENTION:
Care of your Child's Teeth
Good Diet = Healthy Teeth
How Do I Prevent Cavities
Seal Out Decay
Fluoride
Mouth Guards
Xylitol - Reducing
Cavities
ADOLESCENT DENTISTRY:
Tongue Piercing - Is
it Really Cool?
Tobacco - Bad News in Any
Form
For
information on special oral health care needs, we've provided links
to the following sites:
National Institute
of Dental & Craniofacial Research
Resource & Information on Cleft
Lip & Palate
National Foundation for Ectodermal
Dysplasias
GENERAL TOPICS
& FAQ
What Is A Pediatric
Dentist?
The
pediatric dentist has an extra two to three years of specialized
training after dental school, and is dedicated to the oral health of
children from infancy through the teenage years. The very young,
pre-teens, and teenagers all need different approaches in dealing
with their behavior, guiding their dental growth and development,
and helping them avoid future dental problems. The pediatric dentist
is best qualified to meet these needs.
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Why Are The Primary
Teeth So Important?
It
is very important to maintain the health of the primary teeth.
Neglected cavities can and frequently do lead to problems which
affect developing permanent teeth. Primary teeth, or baby teeth are
important for (1) proper chewing and eating, (2) providing space for
the permanent teeth and guiding them into the correct position, and
(3) permitting normal development of the jaw bones and muscles.
Primary teeth also affect the development of speech and add to an
attractive appearance. While the front 4 teeth last until 6-7 years
of age, the back teeth (cuspids and molars) aren’t replaced until
age 10-13.
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Eruption Of Your
Child’s Teeth
Children’s teeth begin forming before birth. As early as 4 months,
the first primary (or baby) teeth to erupt through the gums are the
lower central incisors, followed closely by the upper central
incisors. Although all 20 primary teeth usually appear by age 3, the
pace and order of their eruption varies.
Permanent teeth begin
appearing around age 6, starting with the first molars and lower
central incisors. This process continues until approximately age 21.
Adults
have 28 permanent teeth, or up to 32 including the third molars (or
wisdom teeth).
TOOTH
DEVELOPMENT
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Dental Emergencies
Toothache: Clean the area of the
affected tooth. Rinse the mouth thoroughly with warm water or use
dental floss to dislodge any food that may be impacted. If the pain
still exists, contact your child's dentist. Do not place aspirin or
heat on the gum or on the aching tooth. If the face is swollen,
apply cold compresses and contact your dentist immediately.
Cut or Bitten Tongue, Lip or Cheek:
Apply ice to injured areas to help control swelling. If there is
bleeding, apply firm but gentle pressure with a gauze or cloth. If
bleeding cannot be controlled by simple pressure, call a doctor or
visit the hospital emergency room.
Knocked Out Permanent Tooth:
If possible, find the tooth. Handle it by the crown, not by the
root. You may rinse the tooth with water only. DO NOT clean with
soap, scrub or handle the tooth unnecessarily. Inspect the tooth for
fractures. If it is sound, try to reinsert it in the socket. Have
the patient hold the tooth in place by biting on a gauze. If you
cannot reinsert the tooth, transport the tooth in a cup containing
the patient’s saliva or milk. If the patient is old enough, the
tooth may also be carried in the patient’s mouth (beside the cheek).
The patient must see a dentist IMMEDIATELY! Time is a critical
factor in saving the tooth.
Knocked Out Baby Tooth: Contact your pediatric dentist during
business hours. This is not usually an emergency, and in most
cases, no treatment is necessary.
Chipped or Fractured Permanent Tooth: Contact your
pediatric dentist immediately. Quick action can save the tooth,
prevent infection and reduce the need for extensive dental
treatment. Rinse the mouth with water and apply cold compresses to
reduce swelling. If possible, locate and save any broken tooth
fragments and bring them with you to the dentist.
Chipped or Fractured Baby Tooth: Contact your pediatric dentist.
Severe Blow to the
Head: Take your child to the nearest hospital emergency room
immediately.
Possible Broken or
Fractured Jaw: Keep the jaw from
moving and take your child to the nearest hospital emergency room.
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Dental Radiographs
(X-Rays)
Radiographs (X-Rays)
are a vital and necessary part of your child’s dental diagnostic
process. Without them, certain dental conditions can and will be
missed.
Radiographs detect much
more than cavities. For example, radiographs may be needed to survey
erupting teeth, diagnose bone diseases, evaluate the results of an
injury, or plan orthodontic treatment. Radiographs allow dentists to
diagnose and treat health conditions that cannot be detected during
a clinical examination. If dental problems are found and treated
early, dental care is more comfortable for your child and more
affordable for you.
The American Academy of
Pediatric Dentistry recommends radiographs and examinations every
six months for children with a high risk of tooth decay. On average,
most pediatric dentists request radiographs approximately once a
year. Approximately every 3 years, it is a good idea to obtain a
complete set of radiographs, either a panoramic and bitewings or
periapicals and bitewings.
Pediatric dentists are
particularly careful to minimize the exposure of their patients to
radiation. With contemporary safeguards, the amount of radiation
received in a dental X-ray examination is extremely small. The risk
is negligible. In fact, the dental radiographs represent a far
smaller risk than an undetected and untreated dental problem. Lead
body aprons and shields will protect your child. Today’s equipment
filters out unnecessary x-rays and restricts the x-ray beam to the
area of interest. High-speed film and proper shielding assure that
your child receives a minimal amount of radiation exposure.
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What’s the Best
Toothpaste for my Child?
Tooth brushing is one
of the most important tasks for good oral health. Many toothpastes,
an d/or
tooth polishes, however, can damage young smiles. They contain harsh
abrasives, which can wear away young tooth enamel. When looking for
a toothpaste for your child, make sure to pick one that is
recommended by the American Dental Association as shown on the box
and tube. These toothpastes have undergone testing to insure they
are safe to use.
Remember, children
should spit out toothpaste after brushing to avoid getting too much
fluoride. If too much fluoride is ingested, a condition known as
fluorosis can occur. If your child is too young or unable to spit
out toothpaste, consider providing them with a fluoride free
toothpaste, using no toothpaste, or using only a "pea size" amount
of toothpaste.
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Does Your Child Grind
His Teeth At Night? (Bruxism)
Parents are often concerned about the nocturnal grinding of teeth (bruxism).
Often, the first indication is the noise created by the child
grinding on their teeth during sleep. Or, the parent may notice wear
(teeth getting shorter) to the dentition. One theory as to the cause
involves a psychological component. Stress due to a new environment,
divorce, changes at school; etc. can influence a child to grind
their teeth. Another theory relates to pressure in the inner ear at
night. If there are pressure changes (like in an airplane during
take-off and landing, when people are chewing gum, etc. to equalize
pressure) the child will grind by moving his jaw to relieve this
pressure.
The
majority of cases of pediatric bruxism do not require any treatment.
If excessive wear of the teeth (attrition) is present, then a mouth
guard (night guard) may be indicated. The negatives to a mouth guard
are the possibility of choking if the appliance becomes dislodged
during sleep and it may interfere with growth of the jaws. The
positive is obvious by preventing wear to the primary dentition.
The
good news is most children outgrow bruxism. The grinding decreases
between the ages 6-9 and children tend to stop grinding between ages
9-12. If you suspect bruxism, discuss this with your pediatrician or
pediatric dentist.
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Thumb Sucking
 Sucking
is a natural reflex and infants and young children may use thumbs,
fingers, pacifiers and other objects on which to suck. It may make
them feel secure and happy, or provide a sense of security at
difficult periods. Since thumb sucking is relaxing, it may induce
sleep.
Thumb sucking that persists beyond the eruption of the permanent
teeth can cause problems with the proper growth of the mouth and
tooth alignment. How intensely a child sucks on fingers or thumbs
will determine whether or not dental problems may result. Children
who rest their thumbs passively in their mouths are less likely to
have difficulty than those who vigorously suck their thumbs.
Children should cease thumb sucking by the time their permanent
front teeth are ready to erupt. Usually, children stop between the
ages of two and four. Peer pressure causes many school-aged children
to stop.
Pacifiers are no substitute for thumb sucking. They can affect the
teeth essentially the same way as sucking fingers and thumbs.
However, use of the pacifier can be controlled and modified more
easily than the thumb or finger habit. If you have concerns about
thumb sucking or use of a pacifier, consult your pediatric dentist.
A
few suggestions to help your child get through thumb sucking:
-
Instead of scolding children for thumb sucking, praise them when
they are not.
-
Children often suck their thumbs when feeling insecure. Focus on
correcting the cause of anxiety, instead of the thumb sucking.
-
Children who are sucking for comfort will feel less of a need when
their parents provide comfort.
-
Reward children when they refrain from sucking during difficult
periods, such as when being separated from their parents.
-
Your pediatric dentist can encourage children to stop sucking and
explain what could happen if they continue.
-
If
these approaches don’t work, remind the children of their habit by
bandaging the thumb or putting a sock on the hand at night. Your
pediatric dentist may recommend the use of a mouth appliance.
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What is Pulp Therapy?
The pulp of a tooth is the inner,
central core of the tooth. The pulp contains nerves, blood vessels,
connective tissue and reparative cells. The purpose of pulp therapy
in Pediatric Dentistry is to maintain the vitality of the affected
tooth (so the tooth is not lost).
Dental caries (cavities) and traumatic
injury are the main reasons for a tooth to require pulp therapy.
Pulp therapy is often referred to as a "nerve treatment",
"children's root canal", "pulpectomy" or "pulpotomy". The two
common forms of pulp therapy in children's teeth are the pulpotomy
and pulpectomy.
A pulpotomy removes the diseased pulp
tissue within the crown portion of the tooth. Next, an agent is
placed to prevent bacterial growth and to calm the remaining nerve
tissue. This is followed by a final restoration (usually a
stainless steel crown).
A pulpectomy is required when the entire
pulp is involved (into the root canal(s) of the tooth). During
this treatment, the diseased pulp tissue is completely removed from
both the crown and root. The canals are cleansed, disinfected and,
in the case of primary teeth, filled with a resorbable material.
Then, a final restoration is placed. A permanent tooth would be
filled with a non-resorbing material.
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What is
the Best Time for Orthodontic Treatment?
Developing malocclusions, or bad bites, can be recognized as early
as 2-3 years of age. Often, early steps can be taken to reduce the
need for major orthodontic treatment at a later age.
Stage I – Early Treatment: This period of treatment encompasses
ages 2 to 6 years. At this young age, we are concerned with
underdeveloped dental arches, the premature loss of primary teeth,
and harmful habits such as finger or thumb sucking. Treatment
initiated in this stage of development is often very successful and
many times, though not always, can eliminate the need for future
orthodontic/orthopedic treatment.
Stage II – Mixed Dentition: This period covers the ages of 6 to
12 years, with the eruption of the permanent incisor (front) teeth
and 6 year molars. Treatment concerns deal with jaw malrelationships
and dental realignment problems. This is an excellent stage to start
treatment, when indicated, as your child’s hard and soft tissues are
usually very responsive to orthodontic or orthopedic forces.
Stage III – Adolescent Dentition: This stage deals with the
permanent teeth and the development of the final bite relationship.
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EARLY INFANT
ORAL CARE
Your
Child’s First Dental Visit
According to the American Academy of Pediatric Dentistry (AAPD),
your child should visit the dentist by his/her 1st
birthday. You can make the first visit to the dentist enjoyable and
positive. Your child should be informed of the visit and told that
the dentist and their staff will explain all procedures and answer
any questions. The less to-do concerning the visit, the better.
It
is best if you refrain from using words around your child that might
cause unnecessary fear, such as needle, pull, drill or hurt.
Pediatric dental offices make a practice of using words that convey
the same message, but are pleasant and non-frightening to the child.
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When Will My Baby Start
Getting Teeth?
Teething, the process
of baby (primary) teeth coming through the gums into the mouth, is
variable among individual babies. Some babies get their teeth early
and some get them late. In general, the first baby teeth to appear
are usually the lower front (anterior) teeth and they usually begin
erupting between the age of 6-8 months. See "Eruption
of Your Child’s Teeth" for more details.
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Baby
Bottle Tooth Decay (Early Childhood Caries)
One
serious form of decay among young children is baby bottle tooth
decay. This condition is caused by frequent and long exposures of an
infant’s teeth to liquids that contain sugar. Among these liquids
are milk (including breast milk), formula, fruit juice and other
sweetened drinks.
Putting a baby to bed for a nap or at night with a bottle other than
water can cause serious and rapid tooth decay. Sweet liquid pools
around the child’s teeth giving plaque bacteria an opportunity to
produce acids that attack tooth enamel. If you must give the baby a
bottle as a comforter at bedtime, it should contain only water. If
your child won't fall asleep without the bottle and its usual
beverage, gradually dilute the bottle's contents with water over a
period of two to three weeks.
After each feeding, wipe the baby’s gums and teeth with a damp
washcloth or gauze pad to remove plaque. The easiest way to do this
is to sit down, place the child’s head in your lap or lay the child
on a dressing table or the floor. Whatever position you use, be sure
you can see into the child’s mouth easily.
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PREVENTION
Care of Your Child’s
Teeth
Begin daily brushing as soon as the child’s first tooth erupts. A
pea size amount of fluoride toothpaste can be used after the child
is old enough not to swallow it. By age 4 or 5, children should be
able to brush their own teeth twice a day with supervision until
about age seven to make sure they are doing a thorough job. However,
each child is different. Your dentist can help you determine whether
the child has the skill level to brush properly.
Proper brushing removes plaque from the inner, outer and chewing
surfaces. When teaching children to brush, place toothbrush at a 45
degree angle; start along gum line with a soft bristle brush in a
gentle circular motion. Brush the outer surfaces of each tooth,
upper and lower. Repeat the same method on the inside surfaces and
chewing surfaces of all the teeth. Finish by brushing the tongue to
help freshen breath and remove bacteria.
Flossing removes plaque between the teeth, where a toothbrush can’t
reach. Flossing should begin when any two teeth touch. You should
floss the child’s teeth until he or she can do it alone. Use about
18 inches of floss, winding most of it around the middle fingers of
both hands. Hold the floss lightly between the thumbs and
forefingers. Use a gentle, back-and-forth motion to guide the floss
between the teeth. Curve the floss into a C-shape and slide it into
the space between the gum and tooth until you feel resistance.
Gently scrape the floss against the side of the tooth. Repeat this
procedure on each tooth. Don’t forget the backs of the last four
teeth.
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Good Diet = Healthy
Teeth
 Healthy
eating habits lead to healthy teeth. Like the rest of the body, the
teeth, bones and the soft tissues of the mouth need a well-balanced
diet. Children should eat a variety of foods from the five major
food groups. Most snacks that children eat can lead to cavity
formation. The more frequently a child snacks, the greater the
chance for tooth decay. How long food remains in the mouth also
plays a role. For example, hard candy and breath mints stay in the
mouth a long time, which cause longer acid attacks on tooth enamel.
If your child must snack, choose nutritious foods such as
vegetables, low-fat yogurt, and low-fat cheese, which are healthier
and better for children’s teeth.
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How Do I Prevent
Cavities?
Good oral hygiene
removes bacteria and the left over food particles that combine to
create cavities. For infants, use a wet gauze or clean washcloth to
wipe the plaque from teeth and gums. Avoid putting your child to bed
with a bottle filled with anything other than water. See "Baby
Bottle Tooth Decay" for more information.
For older children,
brush their teeth at least twice a day. Also, watch the
number of snacks containing sugar that you give your children.
The American Academy of
Pediatric Dentistry recommends visits every six months to the
pediatric dentist, beginning at your child’s first birthday. Routine
visits will start your child on a lifetime of good dental health.
Your pediatric dentist
may also recommend protective sealants or home fluoride treatments
for your child. Sealants can be applied to your child’s molars to
prevent decay on hard to clean surfaces.
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Seal Out Decay
A
sealant is a clear or shaded plastic material that is applied to the
chewing surfaces (grooves) of the back teeth (premolars and molars),
where four out of five cavities in children are found. This sealant
acts as a barrier to food, plaque and acid, thus protecting the
decay-prone areas of the teeth.
|
Before Sealant Applied |
After Sealant Applied |
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Fluoride
Fluoride is an element, which has been shown to be beneficial to
teeth. However, too little or too much fluoride can be detrimental
to the teeth. Little or no fluoride will not strengthen the teeth to
help them resist cavities. Excessive fluoride ingestion by
preschool-aged children can lead to dental fluorosis, which is a
chalky white to even brown discoloration of the permanent teeth.
Many children often get more fluoride than their parents realize.
Being aware of a child’s potential sources of fluoride can help
parents prevent the possibility of dental fluorosis.
Some
of these sources are:
-
Too much fluoridated toothpaste at an early age.
-
The inappropriate use of fluoride supplements.
-
Hidden sources of fluoride in the child’s diet.
Two
and three year olds may not be able to expectorate (spit out)
fluoride-containing toothpaste when brushing. As a result, these
youngsters may ingest an excessive amount of fluoride during tooth
brushing. Toothpaste ingestion during this critical period of
permanent tooth development is the greatest risk factor in the
development of fluorosis.
Excessive and inappropriate intake of fluoride supplements may also
contribute to fluorosis. Fluoride drops and tablets, as well as
fluoride fortified vitamins should not be given to infants younger
than six months of age. After that time, fluoride supplements should
only be given to children after all of the sources of ingested
fluoride have been accounted for and upon the recommendation of your
pediatrician or pediatric dentist.
Certain foods contain high levels of fluoride, especially powdered
concentrate infant formula, soy-based infant formula, infant dry
cereals, creamed spinach, and infant chicken products. Please read
the label or contact the manufacturer. Some beverages also contain
high levels of fluoride, especially decaffeinated teas, white grape
juices, and juice drinks manufactured in fluoridated cities.
Parents can take the following steps to decrease the risk of
fluorosis in their children’s teeth:
-
Use baby tooth cleanser on the toothbrush of the very young child.
-
Place only a pea sized drop of children’s toothpaste on the brush
when brushing.
-
Account for all of the sources of ingested fluoride before
requesting fluoride supplements from your child’s physician or
pediatric dentist.
-
Avoid giving any fluoride-containing supplements to infants until
they are at least 6 months old.
-
Obtain fluoride level test results for your drinking water before
giving fluoride supplements to your child (check with local water
utilities).
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Mouth Guards
When
a child begins to participate in recreational activities and
organized sports, injuries can occur. A properly fitted mouth guard,
or mouth protector, is an important piece of athletic gear that can
help protect your child’s smile, and should be used during any
activity that could result in a blow to the face or mouth.
Mouth guards help prevent broken teeth, and injuries to the lips,
tongue, face or jaw. A properly fitted mouth guard will stay in
place while your child is wearing it, making it easy for them to
talk and breathe.
Ask
your pediatric dentist about custom and store-bought mouth
protectors.
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Xylitol - Reducing
Cavities
The American Academy of Pediatric Dentistry (AAPD) recognizes the
benefits of xylitol on the oral health of infants, children,
adolescents, and persons with special health care needs.
The use of XYLITOL GUM by mothers (2-3 times per day) starting 3
months after delivery and until the child was 2 years old, has
proven to reduce cavities up to 70% by the time the child was 5
years old.
Studies using xylitol as either a sugar
substitute or a small dietary addition have demonstrated a dramatic
reduction in new tooth decay, along with some reversal of existing
dental caries. Xylitol provides additional protection that enhances
all existing prevention methods. This xylitol effect is long-lasting
and possibly permanent. Low decay rates persist even years after the
trials have been completed.
Xylitol is widely distributed throughout
nature in small amounts. Some of the best sources are fruits,
berries, mushrooms, lettuce, hardwoods, and corn cobs. One cup of
raspberries contains less than one gram of xylitol.
Studies suggest xylitol intake that consistently produces positive
results ranged from 4-20 grams per day, divided into 3-7 consumption
periods. Higher results did not result in greater reduction and may
lead to diminishing results. Similarly, consumption frequency of
less than 3 times per day showed no effect.
To find gum or other products containing
xylitol, try visiting your local health food store or search the
Internet to find products containing 100% xylitol.
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ADOLESCENT
DENTISTRY
Tongue Piercing – Is
it Really Cool?
You
might not be surprised anymore to see people with pierced tongues,
lips or cheeks, but you might be surprised to know just how
dangerous these piercings can be.
There are many risks involved with oral piercings, including chipped
or cracked teeth, blood clots, blood poisoning, heart infections,
brain abscess, nerve disorders (trigeminal neuralgia), receding gums
or scar tissue. Your mouth contains millions of bacteria, and
infection is a common complication of oral piercing. Your tongue
could swell large enough to close off your airway!
Common symptoms after piercing include pain, swelling, infection, an
increased flow of saliva and injuries to gum tissue.
Difficult-to-control bleeding or nerve damage can result if a blood
vessel or nerve bundle is in the path of the needle.
So
follow the advice of the American Dental Association and give your
mouth a break – skip the mouth jewelry.
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Tobacco – Bad News in Any
Form
Tobacco in any form can jeopardize your child’s health and cause
incurable damage. Teach your child about the dangers of tobacco.
Smokeless tobacco, also called spit, chew or snuff, is often used by
teens who believe that it is a safe alternative to smoking
cigarettes. This is an unfortunate misconception. Studies show that
spit tobacco may be more addictive than smoking cigarettes and may
be more difficult to quit. Teens who use it may be interested to
know that one can of snuff per day delivers as much nicotine as 60
cigarettes. In as little as three to four months, smokeless tobacco
use can cause periodontal disease and produce pre-cancerous lesions
called leukoplakias.
If
your child is a tobacco user you should watch for the following that
could be early signs of oral cancer:
-
A
sore that won’t heal.
-
White or red leathery patches on the lips, and on or under the
tongue.
-
Pain, tenderness or numbness anywhere in the mouth or lips.
-
Difficulty chewing, swallowing, speaking or moving the jaw or
tongue; or a change in the way the teeth fit together.
Because the early signs of oral cancer usually are not painful,
people often ignore them. If it’s not caught in the early stages,
oral cancer can require extensive, sometimes disfiguring, surgery.
Even worse, it can kill.
Help
your child avoid tobacco in any form. By doing so, they will avoid
bringing cancer-causing chemicals in direct contact with their
tongue, gums and cheek.
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